New Cancer Treatment Allows Life-Saving Surgery

Clinical researchers of Norris Cotton Cancer Center at Dartmouth-Hitchcock Medical Center, led by oncologist and principal investigator J. Marc Pipas, M.D., were able to reduce the size of tumours so significantly that a number of patients who previously had been categorised as borderline or inoperable could have their tumours surgically removed.

The overall five-year survival rate for pancreatic cancer is only 4%, but for patients whose tumours can be completely removed, long-term survival jumps to 18-24%. Traditional treatment for pancreatic cancer is surgery followed by chemotherapy and radiation. The treatment Pipas developed reverses the treatment steps: He administers chemotherapy and radiation in combination first, in order to reduce the size of the tumour and increase the possibility of surgery. The reverse treatment regimen results in many tumours previously considered borderline or inoperable shrinking to a size where they could be surgically removed.

In the Norris Cotton Cancer Center trial, 24 patients were treated with short course, high dose chemotherapy of docetaxel and gemcitabine, followed by a combination of radiation and twice-weekly low-dose gemcitabine. Chemotherapy doses in this trial were higher than previously attempted.

Results showed that 50% of tumours shrank by at least a third, including complete disappearance of a tumour in a patient who previously had been judged inoperable. No tumours progressed during treatment.

Seventeen patients in the study underwent surgery, including nine previously considered inoperable or borderline operable. Subsequent follow-up showed that no patient whose tumour was surgically removed had a local recurrence of the disease, and no patient whose disease was considered inoperable had local progression.